From the Guidelines
Neuralgia paresthetica, also known as meralgia paresthetica, is a condition that can be effectively managed with conservative measures and medications, with the primary goal of reducing morbidity, mortality, and improving quality of life. The condition is characterized by tingling, numbness, and burning pain in the outer thigh caused by compression of the lateral femoral cutaneous nerve. Treatment typically begins with conservative measures including weight loss if applicable, avoiding tight clothing around the waist, and taking over-the-counter pain medications like ibuprofen (400-600mg three times daily) or acetaminophen (500-1000mg every 6 hours as needed) 1.
Conservative Measures
- Weight loss if applicable
- Avoiding tight clothing around the waist
- Taking over-the-counter pain medications like ibuprofen or acetaminophen Physical therapy exercises that stretch the hip and thigh muscles can help relieve pressure on the nerve. For more severe cases, a corticosteroid injection near the nerve may provide temporary relief.
Medications
Medications like gabapentin (starting at 300mg daily and gradually increasing to 300-600mg three times daily) or pregabalin (75mg twice daily, increasing as needed) may be prescribed for neuropathic pain, as recommended by the guidelines for the pharmacological management of neuropathic pain 1. Most cases resolve within a few months with these treatments. The condition occurs when the lateral femoral cutaneous nerve becomes compressed as it passes under the inguinal ligament, often due to obesity, pregnancy, tight clothing, or prolonged standing or sitting. In rare cases where symptoms persist despite conservative treatment for over a year, surgical decompression of the nerve might be considered.
Treatment Approach
The treatment approach should follow a step-wise manner, starting with assessing pain and establishing the diagnosis of neuropathic pain, and then initiating therapy with one or more of the first-line medications, such as gabapentin or pregabalin, as recommended by the guidelines 1. The patient should be reassessed frequently to evaluate the effectiveness of the treatment and to adjust the treatment plan as needed. It is essential to consider the potential for adverse effects, treatment of comorbidities, drug interactions, risks of misuse and abuse, and cost when choosing a medication for an individual patient with neuralgia paresthetica 1.
From the Research
Definition and Causes of Neuralgia Parasthetica
- Neuralgia parasthetica, also known as meralgia paresthetica, is a condition caused by entrapment of the lateral femoral cutaneous nerve, leading to paresthesia along the anterolateral portion of the thigh 2, 3.
- The condition can be differentiated from other neurologic disorders by the typical exacerbating factors and the characteristic distribution of symptoms 3.
- The disease process can be either spontaneous or iatrogenic, with the spontaneous form usually being mechanical in origin 3.
Diagnosis and Treatment Options
- Relief of pain and paresthesias after injection of a local anesthetic agent is helpful in establishing the diagnosis 3.
- Treatment options for meralgia paresthetica include nonoperative modalities such as removal of compressive agents, nonsteroidal anti-inflammatory drugs, and local corticosteroid injections 3, 4.
- More invasive options include peripheral nerve stimulation (PNS) 2, radiofrequency ablation 5, neurolysis, and neurectomy 6.
- A systematic review and meta-analysis found that neurectomy had the highest incidence of complete pain relief, followed by neurolysis and then injection 6.
Efficacy of Treatment Options
- Peripheral nerve stimulation (PNS) has been shown to provide complete pain relief in some patients with meralgia paresthetica 2.
- Radiofrequency ablation has been found to reduce average pain scores in patients with refractory meralgia paresthetica 5.
- Ultrasound-guided perineural injections have been found to result in substantial symptom relief in most patients with meralgia paresthetica 4.
- A systematic review and meta-analysis found that the incidence of complete pain relief was 85% after neurectomy, 63% after neurolysis, and 22% after injection 6.